1
The Role of Electronic Health Records and Health
Information Technology in Medical Home
Development

• A. John Blair, III, MD
• CEO, MedAllies

2
Hudson Valley Initiative

• Infrastructure
• EMR
• HIE
• Transformation
• Ambulatory
• Community
• Transparency
• Re-Imbursement Redesign
• Evaluation

3
EHR

• 2008 CCHIT Certification
• NYeC Requirements

4
HIE

• Interoperability
• CCD
• Reporting
• Quality
• Public Health

5
Ambulatory Transformation

• MassPro
• TransforMed
• Community Care of North Carolina

6
MassPro

• NCQA PPC-PCMH
• PPC1 Access and Communication
• PPC2 Patient Tracking and Registry Functions
• PPC3 Care Management
• PPC4 Patient Self-Management Support
• PPC5 Electronic Prescribing
• PPC6 Test Tracking
• PPC7 Referral Tracking
• PPC8 Performance Reporting and Improvement
• PPC9 Advanced Electronic Communication

7
MassPro

• Process for Redesign
• Develop operational vision and goals
• Define redesign teams
• Develop workflow list
• Document current state
• Analyze
• Redesign
• Implement

8
MassPro

• Team Development
• Large practices
• Small practices

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MassPro

• Functional Workflow Diagram

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MassPro

• Outside consultation
• Develop protocols and education
• Develop in-office workflow
• Develop tracking and outreach plan

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MassPro
12

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TransforMed

• Practice Facilitation
• Facilitation team
• Practice Engagement
• Collaborative Meetings
• Dissemination and Sustainability Strategy
• List serves
• Webinars

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TransforMed

• Regular conference calls
• Regular Reports to practices and sponsoring
  institutions
• Kick off event
• Practice PCMH evaluation with pre-work and site
  visit
• Formal report on practice status and
  opportunities

15
TransforMed

• Development of project lists and timelines
• Regular, continuous engagement of practices
• Periodic collaborative meetings
• Early work focusing on leadership, change
  management and team work creating a culture for
  change and success

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Community Care of North Carolina

• Implementing Best Practices
• Implementing Disease Management
• Managing High-Risk Patients
• Managing High-Cost Patients
• Building Accountability

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Community Transformation

• Care Coordination
• Provider to Provider
• Referral
• Consultation
• Inpatient to Outpatient
• Inpatient Discharge
• ED Discharge

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Transparency

• Claims Data
• Clinical Data
• NCQA PPC-PCMH recognition

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Quality Reporting
EHRs
Patient Data
Measures
Aggregator
Summary Measures
Community Information Services
Payers
Providers
20
Reimbursement Reform

• Employers
• Payer
• NY State Employees
• Providers
• Physicians
• Hospitals

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Quality Comittee

• Provider/Payer Consortium
• Quality Measures
• Data Sources
• Attribution Methodology
• Payment Components
• FFS
• Care Coordination Fee
• Outcomes Measures
• Payment Frequency and Timing

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Evaluation

• To determine the effects of implementing the
  Patient-Centered Medical Home in the Hudson
  Valley on
• Health care quality
• Health care cost
• Patient experience

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The Setting Hudson Valley

• 8 suburban and rural counties north of NYC
• 55 of practices have 5 physicians
• National leader in ambulatory adoption of health
  information technology (health IT)
• Excellent track record in community
  transformation
• Hudson Valley Health Information Exchange (HVHIE)
  has been operating for 7 years, making it one of
  the longest running and most successful clinical
  data exchanges in the country

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Distinguishing Features

• Large scale
• 6 health plans that comprise 74 of the
  commercial market
• Aetna
• Empire Blue Cross Blue Shield
• Empire Plan (United HealthCare)
• MVP
• Capital District Physicians Health Plan
• Hudson Health Plan
• 1200 physicians and 1 million patients

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Distinguishing Features

• Informative study design
• Separates medical home from EHRs and
  pay-for-performance (P4P)
• Unique financial incentive model
• Lump sum payment after implementation

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Methods

• Design Prospective cohort study with concurrent
  controls
• Intervention Physicians receive 10,000 each
  after they reach NCQA Level II medical home
• Timing Implementation getting underway
• Participants
• All primary care physicians who are members of
  the Taconic IPA (N 1200)

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Methods

• Participants (contd.)
• A sample of their patients in medical home and
  control practices
• Baseline N 300 medical home 300 control
• Follow-up N 300 medical home 300 control

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Study Groups for Physicians
N Chart Type P4P Medical Home
Group 1 600 Paper No No
Group 2 150 Paper Yes No
Group 3 100 EHR No No
Group 4 100 EHR Yes No
Group 5 250 EHR Yes Yes
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Measurements

• Health care quality
• 10 HEDIS measures
• Aggregated across 6 health plans
• Each year for 4 years (2007-2010)
• Health care utilization
• 18 utilization measures aggregated across 6
  health plans, each year for same 4 years
• Inpatient, outpatient and emergency department,
  thus essentially all utilization

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Measurements

• Patient experience
• Telephone survey based on CG-CAHPS (with
  additional questions from the CMWF International
  Health Policy Survey and ACES), in 2009 and 2011

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Overview of Analysis

• For quality and cost
• Using generalized estimation equations,
  comparisons between study groups and across time,
  adjusting for physician characteristics and case
  mix
• For patient experience
• Adhering to CG-CAHPS guidelines, comparisons
  between study groups and across time, adjusting
  for patient demographics and co-morbidities

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Products

• Hudson Valley experience with medical home
  transformation
• Total and incremental effects (compared to EHRs
  and P4P) of medical home transformation on
  quality
• Total and incremental effects (compared to EHRs
  and P4P) of medical home transformation on cost
• Effect of the medical home transformation on the
  patient experience

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Contribution

• Determine the clinical and economic value of the
  Patient-Centered Medical Home
• Using a fairly unique payment model
• Measured magnitude of cost savings can inform
  future incentive programs
• Determine the incremental quality and economic
  value of the Patient-Centered Medical Home beyond
  that of EHRs and P4P
• Comparison critical to inform community
  activities nationwide

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Contribution

• Maximize reliability and generalizability of
  effect size estimates
• 6 health plans, 1200 physicians and 1 million
  patients

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Priority Focus on Discharge Transitions

• Medicare 30 day readmit rate 17.6 (MedPar)
• Estimated 3/4ths avoidable
• Employed GHS physician readmit rate 17
• Case Mgr phone contact all discharges 24-48 hrs
• Assess transition status, concerns, review plan
• Medication reconciliation
• Confirm or make f/u appointments
• PCP discharge follow up visit 4-7 days

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Decreasing Readmissions
Over 25 reduction Jan-OctYTD 2006 to 2007
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Acute Admission Impacts

• Lewisburg Acute Admits/1000
• Jan-Oct07YTD - 224
• Lewistown Acute Admits/1000
• Jan-Oct07 YTD - 273
• Employed Admits/1000
• Jan-Oct06 YTD - 295
• Jan-Oct07 YTD - 292

14 Reduction 22 Reduction
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Medical Home Care Cost Trend
Medical Home PMPM down 2 vs Network PMPM up 6
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Thank you for your time!

• A. John Blair, III, MD
• CEO, MedAllies, Inc.